Liu WL, Liu HN, Cao MH, Wang HM, Qin XB, Tang JJ, Zhao Y, Ge Y, Han ZX. Immune-nutritional score-based prognostic model for predicting postoperative complications and survival in gastric cancer. World J Gastrointest Surg 2026; 18(7): 119514 [DOI: 10.4240/wjgs.v18.i7.119514]
Corresponding Author of This Article
Zheng-Xiang Han, PhD, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou 221002, Jiangsu Province, China. 18652288252@163.com
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Oncology
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research-article
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Liu WL, Liu HN, Cao MH, Wang HM, Qin XB, Tang JJ, Zhao Y, Ge Y, Han ZX. Immune-nutritional score-based prognostic model for predicting postoperative complications and survival in gastric cancer. World J Gastrointest Surg 2026; 18(7): 119514 [DOI: 10.4240/wjgs.v18.i7.119514]
World J Gastrointest Surg. Jul 27, 2026; 18(7): 119514 Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.119514
Immune-nutritional score-based prognostic model for predicting postoperative complications and survival in gastric cancer
Wen-Lou Liu, Hao-Nan Liu, Meng-Han Cao, Hong-Mei Wang, Xiao-Bing Qin, Juan-Juan Tang, Yang Zhao, Yan Ge, Zheng-Xiang Han
Wen-Lou Liu, Hao-Nan Liu, Meng-Han Cao, Hong-Mei Wang, Xiao-Bing Qin, Juan-Juan Tang, Yang Zhao, Yan Ge, Zheng-Xiang Han, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
Author contributions: Liu WL and Liu HN contributed equally to the conceptualization and design of the study; Liu WL was primarily responsible for data collection and analysis; Liu HN played a key role in interpreting the results and drafting the manuscript; Cao MH, Wang HM, and Qin XB contributed to data analysis and interpretation, and participated in writing and revising the manuscript, also provided valuable feedback on the study’s methodology and analysis; Tang JJ and Zhao Y contributed to the project’s overall management and provided critical feedback on the study’s design and implementation, also contributed to writing and revising the manuscript; Ge Y and Han ZX contributed to the overall management of the project and provided critical feedback on the design and implementation of the research; and all authors played significant roles in the development of the study and approved the final version of the manuscript.
AI contribution statement: This paper did not use any AI tools.
Supported by Pengcheng Talents-Key Medical Talent Training Project, No. XWRCHT20220068.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Xuzhou Medical University, approval No. XYFY2023-KL277-01.
Informed consent statement: The requirement for patients’ informed consent for this study was waived due to its retrospective nature.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used and/or analyzed during the current study are available from the corresponding author.
Corresponding author: Zheng-Xiang Han, PhD, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou 221002, Jiangsu Province, China. 18652288252@163.com
Received: March 10, 2026 Revised: March 31, 2026 Accepted: May 14, 2026 Published online: July 27, 2026 Processing time: 139 Days and 0.7 Hours
Abstract
BACKGROUND
Postoperative complications are common in patients with gastric cancer (GC) and are closely associated with poor prognosis; however, effective tools for preoperative risk stratification remain limited.
AIM
To investigate the predictive value of the immune-nutritional score (INS) for postoperative complications and survival outcomes in patients with GC.
METHODS
We retrospectively reviewed the medical records of 247 patients with GC who underwent curative surgery between January 2019 and December 2022. Postoperative adverse events were categorized using the Clavien-Dindo grading system. Receiver operating characteristics (ROC) curve analyses were performed to evaluate the predictive value of the neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), serum albumin (Alb), and lymphocyte count for postoperative complications. Based on cutoff values, 155 patients were assigned to the low-INS group and 92 to the high-INS group. Overall survival between groups was assessed using Kaplan-Meier survival analysis.
RESULTS
Significant differences were found in body mass index, lymphocyte count, neutrophil count, NLR, Alb, and CRP. Lymphocyte count and Alb were protective factors, whereas neutrophil count, NLR, and CRP were independent risk factors for complications. CRP and Alb showed relatively high predictive performance (area under the receiver operating characteristic curve = 0.9047 and 0.7854, respectively), while INS demonstrated the highest predictive value (area under the receiver operating characteristic curve = 0.9710, 95% confidence interval: 0.9515-0.9904). The incidence of postoperative complications was higher in the high-INS group, and overall survival was lower in the high-INS group (P < 0.001).
CONCLUSION
INS is an effective predictor of postoperative complications and survival outcomes in patients with GC, with strong clinical applicability.
Core Tip: This study proposes an immune-nutritional score, derived from routinely available laboratory parameters, to evaluate the risk of postoperative complications and survival in patients with gastric cancer. By integrating indicators of nutritional status, immune function, and systemic inflammation, immune-nutritional score showed improved predictive performance compared with single markers. It may provide a practical approach for preoperative risk assessment and support individualized perioperative management. Further validation in larger, prospective cohorts is warranted to confirm its generalizability and clinical utility.
